Quality Analyst-Medicare Call Center
Responsible for reviewing recordings of calls with Medicare members to determine if the call was handled in compliance with Medicare requirements and Plan customer service standards
- Provide subject matter expertise in Medicare call requirements
- Provide review, interpretation and implementation of state and federal guidance
- Score calls in accordance with quality scorecard
- Identify trends with call failures
- Mentor and provide feedback on calls
- Oversee and administer ongoing monitoring program(s) based on CMS guidance
- Updates policies, procedures and project work plans as needed.
- Adhere to established corporate policies and procedures
- Perform other duties, as necessary, to meet corporate objectives
- Travel as required
- A minimum of five (5) years experience in a Medicare Advantage call center
- Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint: Required
- Experience with Medicare and/or Medicaid regulations and guidance: Required
- Advanced degree or certification in audit, pharmacy or compliance discipline: Preferred
- Prior project management training and/or experience: Preferred
- Must have strong verbal and written communication skills.
- Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
- Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.